OBJECTIVE: Early gallbladder cancer(EGC), defined as T1 & T2 disease, is frequently curable when completely excised without bile spillage. The objective of the present study is to determine what effect initial laparoscopic cholecystectomy (LC) has on outcome in patients with EGC.
METHODS: Of 63 patients referred to our institution with gallbladder cancer over an eight-year period, 23 underwent initial LC. Fifteen had T1 or T2 disease and are the subjects of this report. These patients were reviewed retrospectively to assess preoperative diagnosis, intraoperative bile spillage, and outcome(recurrence and survival). In addition, the Western literature was reviewed to determine the impact of initial LC on recurrence and survival of patients with EGC.
RESULTS: Six patients had a preoperative ultrasound consistent with a mass in the gallbladder wall. Six had documented bile spillage during the LC. T stage based on LC was T1(n=1) and T2(n=14). Eleven patients underwent re-exploration; of which seven underwent further radical excision (gallbladder liver bed resection, extensive lymphadenectomy and excision of port sites ). After a mean follow-up of 19.1 months, 60% of patients have recurred or died. Three patients had a port site recurrence. Four of 6 patients (67%) with bile spillage at LC have recurred or died of disease. A review of the Western literature of EGC initially removed by LC (including the present series) yielded 21 patients with T1 and 40 patients with T2 disease. One-year survival(T1=89%, T2=69%)and three-year survival (T1=47%, T2=36%) of these patients is worse than prior reports for open cholecystectomy (T1 five-year survival 60-100%).
CONCLUSION: An initial LC with its potential for bile spillage can convert potentially curable EGC to incurable disease. Patients with preoperative findings suspicious for gallbladder cancer should undergo open exploration with intent to perform a radical cancer operation as a primary procedure if the diagnosis is confirmed intraoperatively.